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Medication Dosing Errors in Children

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1. Understanding contributing factors for Medication errors

and patients. The category of cause and category of contributing factors for the SEIP model are included in Table A9 in the appendix. They offer a potential nomenclature for consideration in an update of the SCIRT templates 2. Target interventions to common/high risk factors For example; ? A training program to understand and practice dose related calculations ? Strategies to improve pharmacology knowledge on drug interactions 3. Facilitate a list of factors to target analyses of medications errors (...) and incorrect doses being administered. ? Poor supervision: pressuring students to administer drugs more quickly, ? Pressure from staff: confronting and intimidating behaviour, social isolation- colleagues ? Workload and skill mix. Heavy staff workload (including end of shift/patient transfer pressures, patient load and multitasking Rapid Literature Review 12 Table A8: Work organisation-environment factors associated with medication errors Elderly 1,2 ? Staffing levels ? Workload ? Unclear or lack

2019 Monash Health Evidence Reviews

2. Pediatric Weight Errors and Resultant Medication Dosing Errors in the Emergency Department. (PubMed)

Pediatric Weight Errors and Resultant Medication Dosing Errors in the Emergency Department. An accurate weight is critical for dosing medications in children. Weight errors can lead to medication-dosing errors.This study examined the frequency and consequences of weight errors occurring at 1 children's hospital and 2 general hospitals.Using an electronic medical record database, 79,000 emergency department encounters of children younger than 5 years were analyzed. Extreme weights were first (...) identified using weight percentiles. Encounters with potential weight errors were further evaluated using a retrospective chart review to determine whether a weight error and medication-dosing error occurred.The percentage of weight errors of total encounters at all 3 institutions was low (0.63% on average), but a large proportion of weight errors led to subsequent medication-dosing errors (34% on average). The children's hospital did not have clinically significantly lower occurrences of weight errors

2017 Pediatric Emergency Care

3. Hospitalised children: errors detected by parents and family members

of their children. In one study, parents attributed these errors mainly to communication problems: between healthcare professionals and parents, who sometimes had to call a staff member up to 5 times; between healthcare professionals, for example day and night teams failing to communicate a change in the insulin dose; or via the medical record, for example making entries in the notes for another child. Parents and other family members should be considered as important contributors to the safety (...) Hospitalised children: errors detected by parents and family members Prescrire IN ENGLISH - Spotlight ''Hospitalised children: errors detected by parents and family members'', 1 March 2018 {1} {1} {1} | | > > > Hospitalised children: errors detected by parents and family members Spotlight Every month, the subjects in Prescrire’s Spotlight. 100 most recent :  |   |   |   |   |   |   |   |   |  Spotlight Hospitalised children

2018 Prescrire

4. Medication Dosing Errors in Children

Medication Dosing Errors in Children Medication Dosing Errors in Children Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Medication (...) Dosing Errors in Children Medication Dosing Errors in Children Aka: Medication Dosing Errors in Children II. Precautions: Inaccurate dosing of Acetaminophen in Children Study of n=100, retrospective questionnaire Adults knowing the dosing interval: 86% Adults accurately dosing and measuring the med: 30% Only 40% stated the correct dose One third inaccurately measured the medication Reference Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search

2018 FP Notebook

5. Clinicians: Use “mL”-only when Prescribing to Reduce Parent Dosing Errors and Keep Children Safe

sure they prescribe medications for children in the safest way. Dosing errors are the most common type of medication error that brings children into the Emergency Department. So what can clinicians do? An easy thing clinicians can do is to choose only milliliter (“mL”) units when they prescribe liquid medications, and use mL-only when they talk to families about medication instructions, as recommended by the American Academy of Pediatrics (AAP). A new study found that while three-fifths of primary (...) Clinicians: Use “mL”-only when Prescribing to Reduce Parent Dosing Errors and Keep Children Safe Clinicians: Use “mL”-only when Prescribing to Reduce Parent Dosing Errors and Keep Children Safe | | Blogs | CDC Search Form Controls TOPIC ONLY Search The CDC cancel submit Search Form Controls TOPIC ONLY Search The CDC cancel submit Note: Javascript is disabled or is not supported by your browser. For this reason, some items on this page will be unavailable. For more information about this message

2018 CDC Safe Healthcare blog

6. Medication dosing errors and associated factors in hospitalized pediatric patients from the South Area of the West Bank - Palestine (PubMed)

for a longer time were more likely to have inappropriate doses, so these populations require special care. Many children were hospitalized for infectious causes and antibiotics were widely used. Strategies to reduce pediatric medication dosing errors are recommended. (...) Medication dosing errors and associated factors in hospitalized pediatric patients from the South Area of the West Bank - Palestine Medication dosing errors are a significant global concern and can cause serious medical consequences for patients. Pediatric patients are at increased risk of dosing errors due to differences in medication pharmacodynamics and pharmacokinetics.The aims of this study were to find the rate of medication dosing errors in hospitalized pediatric patients and possible

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2017 Saudi Pharmaceutical Journal : SPJ

7. Pictograms, Units and Dosing Tools, and Parent Medication Errors: A Randomized Study. (PubMed)

Pictograms, Units and Dosing Tools, and Parent Medication Errors: A Randomized Study. Poorly designed labels and dosing tools contribute to dosing errors. We examined the degree to which errors could be reduced with pictographic diagrams, milliliter-only units, and provision of tools more closely matched to prescribed volumes.This study involved a randomized controlled experiment in 3 pediatric clinics. English- and Spanish-speaking parents (n = 491) of children ≤8 years old were randomly (...) assigned to 1 of 4 groups and given labels and dosing tools that varied in label instruction format (text and pictogram, or text only) and units (milliliter-only ["mL"] or milliliter/teaspoon ["mL/tsp"]). Each parent measured 9 doses of liquid medication (3 amounts [2, 7.5, and 10 mL] and 3 tools [1 cup, 2 syringes (5- and 10-mL capacities)]) in random order. The primary outcome was dosing error (>20% deviation), and large error (>2× dose).We found that 83.5% of parents made ≥1 dosing error (overdosing

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2017 Pediatrics Controlled trial quality: uncertain

8. The incidence, prevalence and contributing factors associated with the occurrence of medication errors for children and adults in the community setting: a systematic review.

occurrence for children and adults in the community. Evidence emerging for this review highlighted the incomparability within the included studies and current research and thus the inability to make recommendations to advance the science.Commonly reported causal factors were dosing errors, misreading prescriptions and calculation errors. Therefore, it is recommended that adequate education is provided to ensure that healthcare providers are well equipped to perform the tasks involved in medication (...) The incidence, prevalence and contributing factors associated with the occurrence of medication errors for children and adults in the community setting: a systematic review. Medication delivery is a complex process which provides numerous opportunities for error occurrence. While the community environment presents a unique potential for medication errors, to date, an exploration of these errors had not been conducted.The overall objective of the review was to identify the incidence, prevalence

2017 JBI library of systematic reviews

9. Drug dosing errors in outpatient paediatric patients at primary health-care centres in Nablus: a cross-sectional study. (PubMed)

. 37 drugs were prescribed in a frequency that might be more than needed, whereas 231 drugs were potentially prescribed less frequently than needed. The duration of eight treatments was potentially more than needed, whereas 28 treatments had potentially shorter duration. The potential for inappropriate dosing errors was associated with weight (p=0·006), age (p<0·001), centre (p<0·001), and number of drugs prescribed (p<0·001).Medication dosing errors in young outpatient children in Nablus were (...) Drug dosing errors in outpatient paediatric patients at primary health-care centres in Nablus: a cross-sectional study. Paediatric patients are highly sensitive to drug-related problems such as dosing errors. Some dosing errors are preventable with suitable strategies. The aim of this study was to assess the prevalence of drug dosing errors in outpatient paediatric patients who attended primary health-care centres in Nablus and to identify possible associated factors.For this cross-sectional

2018 Lancet

10. Evaluation of frequency of paediatric oral liquid medication dosing errors by caregivers: amoxicillin and josamycin. (PubMed)

Evaluation of frequency of paediatric oral liquid medication dosing errors by caregivers: amoxicillin and josamycin. To study reconstitution and preparation dosing errors of liquid oral medications given by caregivers to children.A prospective observational study was carried out in the departments of general paediatrics and emergency paediatrics at the Robert-Debré Children's University Hospital. An interview with caregivers involved (1) practical reconstitution and preparation of an oral (...) with the dose-weight pipette. Female sex, native French speaker, and age were significantly associated with correct reconstitution. Male sex and medication were significantly associated with correct preparation.This study highlights the high incidence of errors made by caregivers in reconstituting and preparing doses of these liquid oral medicines, which are associated with considerable risks of over- and underdosing. Factors associated with these errors have been identified which could help health

2016 Archives of Disease in Childhood

11. Liquid Medication Errors and Dosing Tools: A Randomized Controlled Experiment. (PubMed)

controlled experiment in 3 urban pediatric clinics. English- or Spanish-speaking parents (n = 2110) of children ≤8 years old were randomly assigned to 1 of 5 study arms and given labels and dosing tools that varied in unit pairings. Each parent measured 9 doses of medication (3 amounts [2.5, 5, and 7.5 mL] and 3 tools [1 cup, 2 syringes (0.2- and 0.5-mL increments)]), in random order. Outcome assessed was dosing error (>20% deviation; large error defined as > 2 times the dose).A total of 84.4% of parents (...) Liquid Medication Errors and Dosing Tools: A Randomized Controlled Experiment. Poorly designed labels and packaging are key contributors to medication errors. To identify attributes of labels and dosing tools that could be improved, we examined the extent to which dosing error rates are affected by tool characteristics (ie, type, marking complexity) and discordance between units of measurement on labels and dosing tools; along with differences by health literacy and language.Randomized

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2016 Pediatrics Controlled trial quality: uncertain

12. Incidence and determinants of medication errors and adverse drug events among hospitalized children in West Ethiopia. (PubMed)

Incidence and determinants of medication errors and adverse drug events among hospitalized children in West Ethiopia. Medication errors cause a large number of adverse drug events with negative patient health outcomes and are a major public-health burden contributing to 18.7-56 % of all adverse drug events among hospitalized patients. The aim of this study was to assess the incidence and determinants of medication errors and adverse drug events among hospitalized children.A prospective (...) observational study was conducted among hospitalized children in the pediatrics ward of Nekemte Referral Hospital from February 24 to March 28, 2014. Data were collected by using checklist guided observation and review of medication order sheets, medication administration records, and other medical charts of the patients. To identify the independent predictors of medication errors and adverse drug events, backward logistic regression analysis was used. Statistical significance was considered at p-value

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2016 BMC Pediatrics

13. Assessing the Impact of the Anesthesia Medication Template on Medication Errors During Anesthesia: A Prospective Study. (PubMed)

anesthetizing locations during a 2-year period at Seattle Children's Hospital, an academic, pediatric medical center.In simulated emergencies, the odds of medication dosing errors using the AMT were 0.21 times the odds of medication dosing errors without AMT (95% confidence interval [CI], 0.07, 0.66), controlling for scenario, session, training level, and years at training level. During the year after implementation of the AMT, the mean monthly error rate for all reported medication errors that reached (...) Assessing the Impact of the Anesthesia Medication Template on Medication Errors During Anesthesia: A Prospective Study. Medication errors continue to be a significant source of patient harm in the operating room with few concrete countermeasures. The organization and identification of medication syringes may have an impact on the commission of medication errors in anesthesia, so a team of physicians and designers at the University of Washington created the Anesthesia Medication Template (AMT

2017 Anesthesia and Analgesia

14. What causes prescribing errors in children? Scoping review. (PubMed)

differences led to individualised dosing and calculations; off-licence prescribing; medication formulations; communication with children; and experience working with children. Primary evidence clarifying causes was lacking.Specific factors complicate prescribing for children and increase risk of errors. Primary research is needed to confirm and elaborate these causes of error. In the meantime, this review uses existing evidence to make provisional paediatric-specific recommendations for policy, practice (...) What causes prescribing errors in children? Scoping review. (1) Systematically assemble, analyse and synthesise published evidence on causes of prescribing error in children. (2) Present results to a multidisciplinary group of paediatric prescribing stakeholders to validate findings and establish how causative factors lead to errors in practice.Scoping review using Arksey and O'Malley's framework, including stakeholder consultation; qualitative evidence synthesis.We followed the six scoping

2019 BMJ open

15. Incidence, characteristics, and predictive factors for medication errors in paediatric anaesthesia: a prospective incident monitoring study. (PubMed)

Incidence, characteristics, and predictive factors for medication errors in paediatric anaesthesia: a prospective incident monitoring study. Medication errors are not uncommon in hospitalized patients. Paediatric patients may have increased risk for medication errors related to complexity of weight-based dosing calculations or problems with drug preparation and dilution. This study aimed to determine the incidence of medication errors in paediatric anaesthesia in a university paediatric (...) during the study period with 37 reporting at least one medication error (2.6%). Drugs most commonly involved in medication errors were opioids and antibiotics. Incorrect dose was the most frequently reported type of error (n=27, 67.5%), with dilution error involved in 7/27 (26%) cases of incorrect dose. Duration of procedure >120 min was the only factor independently associated with medication error [adjusted odds ratio: 4 (95% confidence interval: 2-8); P=0.0001].Medication errors are not uncommon

2018 British Journal of Anaesthesia

16. Liquid Medication Dosing Errors in Children: Role of Provider Counseling Strategies (PubMed)

Liquid Medication Dosing Errors in Children: Role of Provider Counseling Strategies To examine the degree to which recommended provider counseling strategies, including advanced communication techniques and dosing instrument provision, are associated with reductions in parent liquid medication dosing errors.Cross-sectional analysis of baseline data on provider communication and dosing instrument provision from a study of a health literacy intervention to reduce medication errors. Parents whose (...) children (<9 years) were seen in 2 urban public hospital pediatric emergency departments (EDs) and were prescribed daily dose liquid medications self-reported whether they received counseling about their child's medication, including advanced strategies (teachback, drawings/pictures, demonstration, showback) and receipt of a dosing instrument. The primary dependent variable was observed dosing error (>20% deviation from prescribed). Multivariate logistic regression analyses were performed, controlling

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2014 Academic pediatrics

17. Medication errors by caregivers at home in neonates discharged from the neonatal intensive care unit. (PubMed)

Medication errors by caregivers at home in neonates discharged from the neonatal intensive care unit. To determine the frequency of medication errors by caregivers at home in neonates discharged from the neonatal intensive care unit and to identify the associated risk factors.A descriptive, cross-sectional study was conducted in the High Risk Newborn Follow-up Clinic of our institute, on a sample of 166 children, <3 months old. The medications prescribed (syrup preparations of vitamin D (...) summary. Various risk factors probably associated with medication errors, were noted.The frequency of medication errors by caregivers in infants discharged from the neonatal intensive care unit was 66.3%. Dose administration error, that is, measurement of a dose different from what was prescribed was the most common error (54%). A prescription containing more than three drugs was found to have statistically significant association (OR 4.19, CI 1.59 to 11.07, p=0.00).Medication errors by caregivers

2017 Archives of Disease in Childhood

18. A Mobile Device App to Reduce Medication Errors and Time to Drug Delivery During Pediatric Cardiopulmonary Resuscitation: Study Protocol of a Multicenter Randomized Controlled Crossover Trial (PubMed)

A Mobile Device App to Reduce Medication Errors and Time to Drug Delivery During Pediatric Cardiopulmonary Resuscitation: Study Protocol of a Multicenter Randomized Controlled Crossover Trial During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusions is complex and time-consuming. The need for individual specific weight-based drug dose calculation and preparation places children at higher risk than adults for medication errors. Following (...) an evidence-based and ergonomic driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. In a prior single center randomized controlled trial, medication errors were reduced from 70% to 0% by using PedAMINES when compared with conventional preparation methods.The purpose of this study is to determine whether the use of PedAMINES

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2017 JMIR Research Protocols Controlled trial quality: predicted high

19. Radiation dose monitoring software for medical imaging with ionising radiation

frequent UK dose surveys need to be done. These surveys will provide data to support regular updating of national DRLs, including those specifically for children. Manual and semi-automatic recording of radiation dose data requires data entry in the radiology information system, a spreadsheet or on paper. This is time consuming and may result in an error rate of up to 6% (Noumeir 2005, Boos et al. 2015). The 2011 review of the Public Health England report CRCE-013: Doses from CT examinations in the UK (...) Radiation dose monitoring software for medical imaging with ionising radiation Radiation dose monitoring software for medical Radiation dose monitoring software for medical imaging with ionising r imaging with ionising radiation adiation Medtech innovation briefing Published: 31 October 2017 nice.org.uk/guidance/mib127 pathways Summary Summary The technologies technologies described in this briefing are 8 radiation dose monitoring software technologies that automatically gather and analyse

2017 National Institute for Health and Clinical Excellence - Advice

20. Pharmaceutical Dosing Errors at a Pediatric HIV Clinic in Mwanza, Tanzania. (PubMed)

Pharmaceutical Dosing Errors at a Pediatric HIV Clinic in Mwanza, Tanzania. The outpatient medication dosing error rate at a pediatric HIV clinic in Mwanza, Tanzania, was about 1 in every 34 prescriptions. Young children were at highest risk of a dosing error likely because of dose changes with growth and also the inconsistent supply of pediatric formulations. Majority of errors occurred at consecutive visits suggesting clinicians reordered medication without double checking dosing.

2017 Pediatric Infectious Dsease Journal

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